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Chronic High (Proximal) Hamstring Tendinopathy

Athletes who complain of deep buttock pain, pain when sitting, or deep, posterior, upper thigh pain may be suffering from high (proximal) hamstring tendon injury. Chronic high hamstring tendinopathy is becoming increasing recognized as a causative factor in both sitting and activity-related posterior hip pain.1,2,3 Unlike an acute tear, the pain usually comes on gradually and may be aggravated by repetitive activities, such as running or biking, and worsened by prolonged sitting.

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How Does the Pain Develop?

The body has many tendons, which anatomically are fibrous tissues that connect muscle to bone. The proximal hamstring tendons connect the three hamstring muscles (the semimembranosus, the semitendinosus, and the biceps femoris) to the sit bone (ischial tuberosity), which is located in the buttocks at the bottom of the pelvic bone. These tendons are prone to injury, particularly in activities that require repetitive motion, such as running or rowing, or those that require prolonged sitting. (The distal hamstring tendons connect the hamstrings to the tibia, or shinbone, just below the knee joint.)

All muscles have origins and insertions, where their tendons attach muscle to bone. In the pelvis the hamstring origin occurs at the bottom of pelvis on a bone called the ischial tuberosity (sit bone). The semitendinosus and biceps femoris muscles blend together and share a common origin at the ischial tuberosity (sit bone) called the conjoint tendon. The semimembranosus tendon has a separate origin just to the outside (lateral to) the conjoint tendon origin.7

While the conjoint tendon is the most commonly affected hamstring tendon, the symptoms, diagnosis, and treatment options for the semimembranosus tendon is the same.